title: When life-sustaining treatment is withdrawn and the patient doesn't die.
abstract: One of the most difficult decisions that doctors and parents must make is the decision to withdraw life-sustaining treatment. Doctors find it easier to withdraw treatments in situations where withdrawal will be rapidly fatal rather than in situations in which treatment withdrawal will lead to a prolonged dying process. Mechanical ventilation is usually such a treatment. Withdrawal of ventilation generally leads to the patient's rapid demise. Doctors may tell parents that death will occur quickly after a ventilator is withdrawn. But what happens when the doctors are wrong and a patient survives without life support? What should doctors do next? We present a case in which that happened and asked 3 experts to comment on the case. Stefan Kutzsche is a senior consultant in neonatology at Oslo University Hospital Ulleval in Norway. John Colin Partridge is a neonatologist and professor of pediatrics at University of California, San Francisco. Steven R. Leuthner is a neonatologist and professor of pediatrics and bioethics at the Medical College of Wisconsin. They each recommend slightly different approaches to this dilemma.
authors.affiliation: Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, 64108. jlantos@cmh.edu.
authors.forename: Stefan
authors.initials: S
authors.lastname: Kutzsche
authors.forename: John Colin
authors.initials: JC
authors.lastname: Partridge
authors.forename: Steven R
authors.initials: SR
authors.lastname: Leuthner
authors.forename: John D
authors.initials: JD
authors.lastname: Lantos
mesh_terms: D017809:Fatal Outcome; D005317:Fetal Growth Retardation / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007223:Infant; D062071:Infant, Extremely Premature; D008020:Life Support Care / Q000941:ethics*; D008297:Male; D010166:Palliative Care / Q000941:ethics; D012121:Respiration, Artificial / Q000941:ethics*; D013997:Time Factors; D028761:Withholding Treatment / Q000941:ethics*
keywords: Ethics; palliative care; prognostication; withdrawal of life-sustaining treatment